Who would have thought that the American aircraft and movie 'industries billionaire, Howard Hughes, old die in a state of nudity because he feared clothes would contaminate him? He had such a dread of germs that he refused to meet people, spend hours washing and grooming,sealed windows and doors with paper towels and tissues and had his food wrapped in special tissues. As he grew older, the elaborate toilet involved such an overwhelming effort that he stopped cleaning himself. These so-called "fears" actually indicate a psychiatric condition called Obsessive-Compulsive Disorder.
What is Obsessive-Compulsive Disorder?
Every person washes and cleans his house and himself. Every person checks light, gas and the lock before leaving the house. But when the person is not satisfied after checking or cleaning once or even twice but feels again and again compelled to perform the same activities, we talk in terms of it being a disease or disorder.
Obsessive-Compulsive Disorder (OCD) is an anxiety disorder where unwanted thoughts or impulses keep coming repeatedly in a person's mind compelling him/her to do certain actions again and again to relieve anxiety caused by those thoughts. These obsessive thoughts cause him/her distress as they are found to be foolish, frightening, disgusting, painful or trivial by the person. Typically, the person tries to ignore or suppress it or even tries to neutralize it with another thought or action. But despite trying to push the thoughts away from his mind he is unable to do so. Some of the common types of obsessions are thoughts of harm,contamination and doubt. The thoughts may range from the ideas of loosing control, sinful thoughts against one's religion, fear of contamination, getting AIDS, harming someone, sexual images, repeatedly counting everything and so on.
Compulsions are behaviors that help relieve anxiety from these unwanted and intrusive thoughts. The person feels compelled to do something again and again so that the unwanted thoughts are somehow controlled. However, the repeated actions bring relief only temporarily. In most cases the person usually realizes that the repeated actions are excessive and irrational. Some com- I moon repetitive rituals are like washing
and grooming, touching objects in a specific way, checking locks, light switches and gas, checking whether he/she has hurt someone, repeatedly putting omni clothes and then taking them off, repeating certain actions like going through the doorway several times, counting objects like steps, hoarding items like old newspaper, scraps and used containers. The list is endless.
Typical Obsessions and Compulsions
In order to understand the problem better mental health professionals have sub-categorized the types on the basis of the rituals performed. There are basically four types of obsessions and compulsions. The most common is the obsession of cc ftitaminationand the compulsion is to wash; In this type, the individual may wash his/her hands repeatedly after touching objects like feces and urine that are hard to avoid. The second type of obsession is that of doubt which involves the compulsion of checking. In this the person may make several trips back home to see whether he/she has switched off the gas stove and lights and locked the door. The third type of obsess ional thoughts may be centered on sexual and aggressive acts. In yet another type, compulsions and obsessions appear to fuse together and are known as obsess ional slowness.Here, an individual may be taking hours. to complete simple daily rituals like shaving and eating.
Why does obsessive-compulsive disorder occur?
Till recently this disorder was considered a rare condition but of late studies indicate that as many as 2% of the population suffers from it. Both men and women are equally afflicted. This disorder begins around early 20s. Unfortunately, most persons are able to hide it wetland treatment only begins once the patient has become so dysfunctional that it is brought to everyone's notice. In quite a few cases, the obsessive-compulsive patient also feels .depressed and may even be suicidal. Several theories have offered to explain the phenomena but unfortunately not a single theory gives a complete picture. However,
certain important pointers have been given by two theories. Genetic studies show that some 3-7% of the first-degree relatives are predisposed to get this illness. Learning theory, however, emphasizes that obsessive-compulsive symptoms are learned. The explanation given is that a person learns the association between a neutral thought and an anxious thought. Over time the neutral thought itself, becomes an anxious thought.
Compulsions are learnt differently. By doing certain actions, a person may discover, that his anxiety has been reduced. He learns to perform these actions every time he feels anxious; Over a period of time the person routinely does these rituals to reduce anxiety.
How do get rid of these symptoms?
The most effective way to treat the disorder is to combine both pharmacological and psychological methods. Amongst the psychological methods, the most frequently used is expo-.sure and response prevention. In this method, the patient is gradually exposed to the anxiety-provoking situation. For example, if the person fears dirt and contamination and washes his hands say twenty times, he is compulsorily exposed to dirt and prevented fromwashing it off. Initially this therapeutic method increases anxiety but over time the patient realizes that there is actually nothing to feel scared about and the level of anxiety reduces. Efforts are made to educate him about healthy cleaning and excessive cleaning. A fa.irly high success rate of 60-75% has been reported with these methods.
Some other methods used are "thought stopping", "graded exposure", "implosion" etc.. Since these patients are exceedingly anxious they require a lot of reassurance and emotional support and the added irritation of the rigid rituals sometimes makes it difficult to accommodate the patient and his whims. Hence, the family has to be counseled as well. In some cases marital therapy may be required where the patient refuses to have physical relations because of the fear of contamination.The sooner the patient is diagnosed and treated the better for him and the family.
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